The Department of Health (DOH) certifies four types of emergency medical services (EMS) professionals:  emergency medical responders (EMRs), emergency medical technicians (EMTs), advanced EMTs, and paramedics.

The DOH also licenses ambulance services and requires ambulances to meet specified minimum staffing requirements.  All ambulances must include at least one EMT, but other staffing requirements differ depending on the level of care provided by the ambulance service.  Levels of care include basic life support, intermediate life support, advanced life support, and specialty care transport.  Specialty care transports provide care for patients who are critically injured or ill and require care by a physician, registered nurse, or paramedic with special training.  Specialty care transports are interfacility, meaning the patient moves from one medical facility to another medical facility.

Department of Health regulations require that an ambulance service providing interfacility specialty care transports includes a minimum of two certified or licensed health care providers on each transport.  One of these providers must be either a paramedic or a registered nurse certified as an EMT.  The other provider must be a registered nurse, respiratory therapist, EMT, advanced EMT, paramedic, or another appropriate specialist as appointed by the physician director of the ambulance service. 

When no paramedic or registered nurse with EMT certification is available, a registered nurse without an EMT certification may fulfill the provider requirement during an interfacility specialty care transport under the following circumstances:

• there is an EMT in the ambulance;
• the nurse has appropriate competencies to provide care to the patient;
• the ambulance service does not have a paramedic available; and
• the sending hospital does not have a nurse with EMT certification available.

A registered nurse without EMT certification who provides patient care during an interfacility specialty care transport must follow the direction of the sending or receiving physician.  When a nurse without EMT certification participates in an interfacility specialty care transport, the nurse must work within the registered nurse scope of practice.  The sending hospital should coordinate with the ambulance service to confirm that the nurse is familiar with the equipment and medical supplies in the ambulance before participating in the transport.

"Specialty care transport" means the level of care or service needed during an interfacility transport for a patient who is critically injured or ill and whose condition requires care by a physician, registered nurse with appropriate competencies, or a paramedic who has received special training and approval of the medical program director.

"Interfacility transport" means medical transport of a patient between recognized medical treatment facilities requested by a licensed health care provider.

(In support) This bill addresses a clear problem in which rural hospitals do not have enough nurses with EMT certification to staff interfacility transports.  Other options, such as relying on staff from neighboring counties, ambulance services from a nearby city, or air transport are not good solutions.  It can take several hours for an ambulance from an urban area to arrive, and there are times of the year when air transport is not possible.  The bill should be broadened to allow nurses to work on ambulances in other situations, because this can further reduce the burden.

(Opposed) None. 

(Other) There are concerns that the bill does not contain standardized hands-on training for nurses working in the ambulance.  The equipment in an ambulance is very different from a hospital environment.  The only person who knows how to operate the equipment might be driving, and it is not clear what would happen if the patient's condition changes and the nurse no longer has appropriate competencies. 

(In support) Representative Joe Schmick, prime sponsor; Katie Kolan, Washington State Hospital Association; Shane McGuire; Joey Rodrigues, Executive Director, Olympic Ambulance Service, Inc.; and Zane Gibbons, Chief Nursing Officer, Ferry County Health.